Application of a new type of eyelid blepharoplasty through the lower eyelid margin incision in mid-face rejuvenation

Objective·To explore the application effect of a new type of blepharoplasty with a lower eyelid margin incision in the mid-face rejuvenation.Methods·From September 2019 to September 2022, 35 patients with lower eyelid pouches, eyelid-cheek junction depression, and mid-face sagging were treated in Department of Plastic Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine. The surgical procedure involved incising the lower eyelid margin of the patient, bluntly separating the orbital zygomatic space and maxillary space, and opening the orbital septum to release the orbital fat flap. Subsequently, the fat flap was spread downward to cover the infraorbital margin and fixed onto the zygomatic bone membrane. Then, the maxillary space was separated below the orbital zygomatic ligament, and the composite tissue in the infraorbital area was suspended and fixed outward and upward. The lateral orbicularis oculi muscle of the lower eyelid was suspended and fixed on the periosteum above the lateral orbital canthus, lifting the relaxed soft tissue in the mid-face. The upper and lower orbicularis oculi muscles were sutured to form a reclining silkworm, restoring the original tissue structure and morphology under the orbit. Outpatient follow-up visits were conducted at 1, 3, and 6 months postoperatively, with digital cameras capturing frontal, left lateral and right lateral views. Postoperative complications were recorded, including subcutaneous bruising, swelling, conjunctival edema, hematoma, eyelid separation, lower eyelid eversion, diplopia, strabismus, dry eyeball, and tear overflow. The patients were followed up irregularly 6‒12 months after surgery to observe the long-term effects.Results·All 35 patients were followed up for 6 to 12 months after surgery, with all incisions healing primarily. The blepharoplasty, palpebral sulcus depression, and nasolabial sulcus folds were significantly improved. The sagging tissue of the mid-face was reduced, and the effect was satisfactory. No complications, such as lower eyelid retraction, ectropion, or infection, occurred.Conclusion·The new type of eyelid blepharoplasty through the lower eyelid margin incision can significantly rejuvenate the lower eyelid and mid-face. This method has less trauma, less bleeding, reliable effect, and is easy to promote.